Egret and crab

Thursday, February 4, 2010

Speaking your mind

There was a fantastic study published yesterday in the New England Journal of Medicine that I was alerted to by the Huffington Post.  It is titled Willful Modulation of Brain Activity in Disorders of Consciousness and authored by Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D.

The study took 23 patients in vegetative states of consciousness and 31 that were minimally conscious and gave them a baseline MRI. They then trained them to visualize two specific mental images to answer their questions.

Of the 54 patients in the study, five were able to willfully modulate their brain activity to answer questions.

Here is the abstract of the paper:

Background The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished.
Methods At two major referral centers in Cambridge, United Kingdom, and Liege, Belgium, we performed a study involving 54 patients with disorders of consciousness. We used functional magneticresonance imaging (MRI) to assess each patient's ability to generate willful, neuroanatomically specific, blood-oxygenation-level–dependent responses during two established mental-imagery tasks. A technique was then developed to determine whether such tasks could be used to communicate yes-or-no answers to simple questions.
Results Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.
Conclusions These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.

This type of study shows just how far this cutting edge research has come and gives hope for families with living comatose or vegetative relatives.  Also an even stronger appreciation for the breadth of the human spirit and the reach of the human mind. You have to wonder how many lights may have been mistakenly turned off that still were burning and perceiving their world?


shawnintland said...


Having lost a good friend to the "Twilight Zone" due to a motorcycle accident late last year, I was excited to see this report too. I think that the very first thing I would tell my friend at the beginning of any testing is the fact that 'if' he hears the questions being asked of him, he needs to be aware that even if his own choice is to cut the life support, by indicating this he is shutting the door on that very possibility.
Jeffery indicated in his 'living will' that in such a case as his, he did not want to be kept on life support. Unfortunately, that judgment is a lot harder to make when the situation becomes 'real'.
I think this study will raise loads of new issues but am sure that there will be some life-changing effects because of it.

Blue Heron said...

I am not sure that I understand. Are you saying that any affirmative response that suggests cognition will negate the possibility of them pulling the plug, even if he or she would rather check out? Or what are you saying?

shawnintland said...

Yep, by acknowledging that they can even perceive the question being asked they are proving they are not "brain dead".

Blue Heron said...

We discussed this at breakfast. Most thought that the majority of people would not wish to continue in that manner or zone, cognitive or not.